A 15 year male presented with pain in inguinal area and lower abdomen presents with tenderness over a non-reducible swelling with negative cough impulse. Diagnosis:

Ans. (a) Strangulated herniaRef: Sabistan 19th ed. /1127* Strangulation occurs more often in patients who have worn a truss for a long time and in those with a partially reducible or an irreducible hernia* Indirect inguinal hernias strangulate more commonly, the direct variety not so often because of the wide neck of the sac.* MC constricting agent: Neck of the sac > External inguinal ring in children > Adhesions within the sac.* MC contents: Small intestine > OmentumClinical features of strangulated inguinal Hernia* Sudden onset inguinal pain* Generalized abdomen pain* Tense and extremely tender hernia* Discoloration of overlying skin with a reddish or bluish tinge* There is no expansile cough impulse.